Dr. Susan Fernyak has battled against infectious diseases for more than two decades.
The Madison High School graduate, now the chief medical officer at the San Mateo Medical Center in California, quickly confesses that fighting against any virus is a tough battle, including the new strain of the coronavirus that has caused the COVID-19 pandemic.
Rather than a bacterial infection, which can often be eradicated with the right antibiotic, successful treatments for a new virus are difficult, scientific-intensive and time-consuming to develop.
Viruses are smaller than bacteria and require living hosts — such as people, plants or animals — to multiply. Otherwise, they can’t survive. When a virus enters your body, it invades some of your cells and takes over the cell machinery, redirecting it to produce the virus.
“We have developed treatments for HIV (the virus that causes AIDS), but it took a good decade to find a good combination of drugs that work,” said Fernyak, who spent 13 years with the San Francisco Department of Public Health, including eight as its director.
“Viral diseases are much more complicated. We have medicines that keep HIV at bay, but you don’t actually get rid of it. You are likely on HIV meds for life.
“We have treatments for Hepatitis B and C, but it took a long time to find combinations that really work,” the 58-year-old told Richland Source this week. “Viruses are so much harder to treat or kill.”
SEEKING TREATMENTS: As the world works feverishly on a prevention vaccine that may be a year away, physicians like Fernyak are working just as hard to discover successful medicines to reduce a COVID-19 patient’s “viral load” while the body fights it off.
One such treatment being employed in the San Francisco Bay area is a combination of two older drugs — chloroquine and azithromycin.
The former was approved for use in 1955 to treat malaria and is also now used for rheumatoid arthritis and lupus. Azithromycin, an antibiotic used to treat bacterial infections, was approved for medical use in 1988.
The combination treatment, which became politically charged when President Donald Trump endorsed its possibilities in March, has been approved by the FDA for emergency usage for COVID-19 patients even as clinical trials continue around the world.
An international poll of thousands of doctors rated chloroquine as the best treatment for coronavirus, according to a story in the New York Post.
“Of the 6,227 physicians surveyed in 30 countries, 37 percent rated hydroxychloroquine the ‘most effective therapy’ for combating the potentially deadly illness,” the April 2 story said.
Fernyak, while admitting there is not a depth of knowledge about how the drugs work against the new strain of coronavirus, said it has become “community standard” in hospitals throughout the San Francisco Bay area to begin administering the drugs to all patients hospitalized with COVID-19.
“With this disease, it’s very hard to predict who will get really sick from the virus,” Fernyak said, adding that older people and those with underlying chronic conditions cause the most concern. “(But) anyone can get really sick with this disease. It’s hard to determine (early) which patients will end up on a ventilator.”
MEDICAL RESOURCES: Fernyak said the goal is to successfully treat patients without having to admit them into the hospital.
If they must be admitted, the goal becomes to keep them off a ventilator. If they require a ventilator, the goal is to get them off the machine as quickly as possible.
Unfortunately, she said, COVID-19 patients on average require more time on a ventilator than those with pneumonia.
That’s why “flattening the curve,” i.e. slowing down the virus spread, is essential. There are a finite number of medical resources, including ICU beds, nurses, ventilators, etc.
“We have to reduce the rate at which people will get sick (and need hospitalization),” Fernyak said. “We have limit the flow into ICU beds. That’s the only way to save as many lives as possible.”
She said California has successfully slowed the number of patients requiring ICU rooms and ventilators by implementing social distancing procedures required by the state government.
“It’s unbelievable … there is no one (outside) here. It’s the weirdest thing ever. There are millions of people in the Bay area and no one is out,” Fernyak said.
Fernyak earned a bachelor’s degree in religious studies at Dartmouth College in 1984 and her medical degree from Dartmouth in 1992. She also obtained a master’s degree in public health and epidemiology from the University of California in Berkeley.
Even with her medical training and practice, COVID-19 is something new. She admitted the medical community is learning something new every day.
“HIV was a very different disease. In the beginning, we didn’t know much … but it became clear it didn’t impact everyone equally. With COVID-19, it doesn’t matter who you are or what you are … no one can predict who will get it.
“We know more about (COVID-19) early on than we did about HIV. When you look at SARS (severe acute respiratory syndrome), which was a similar coronavirus, it didn’t spread as quickly. Groups of people were impacted, but it was not as widespread,” Fernyak said.
SARS appeared in 2002 in China and spread worldwide within a few months, though it was contained and no known transmission has occurred since 2004. According to the World Health Organization, 8,098 people worldwide became sick with SARS during the outbreak. Of these, 774 died. In the United States, only eight people had laboratory evidence of SARS infection.
The veteran physician is not sure how quickly this new coronavirus will be contained and when things may return to normalcy.
“There are a lot of opinions. Herd immunity is something we count on with most viral diseases. We don’t know if this new coronavirus will go that way.
“I don’t think we really know enough about it yet. There are lot of things about it we just don’t have the answer for yet.”
